Lecture 6 Flashcards
Atypical ribs
1 and 2 because of their narrowness
The _______ cartilage gives the ribs a little bit of flexibility.
hyaline
What vasculature sits in the groove of the first and second rib.
subclavian artery and vein
Nerves in the intercostal space come from the __________ chain.
sympathetic
Greater Splanchnic nerves
T5-T9, T10
Lesser Splanchnic nerves
T10, T11
Least Splanchnic nerves
T11, T12; past the diaphragm
Pretracheal fascia continues with the ___________ fascia.
endothoracic
Most important drainage structure in the thorax.
thoracic duct
Typical Spinal Nerves (T2-T11)
main nerve, dorsal root ganglion, connects with both dorsal and ventral portions; Fibers of internal oblique are innervated by those spinal nerves that pass through the muscle fibers (including the intercostals and abdominals)
Atypical Spinal Nerves (T1-T2)
T1 divided into two parts (superior and inferior)
associated with stellate ganglion (landmark for numbing all thoracic viscera)
Subcostal nerve (T12)
part of lumbar plexus, does not have collateral branch but is destined to simply form a plexus (not meant to work alone)
Thoracic Wall Joints
Intervertebral - symphysis (move slightly); Costovertebral - synovial (move freely); Costochondral - cartilaginous (hyaline, flexible); Interchondral - synovial (move freely - have a capsule); Sternocostal- cartilaginous; Sternoclavicular- synovial (not in joint but flows over); Manubriosternal, xiphisternal - cartilaginous
The _______ is one of the strongest bones, second to the mandible.
sternum
Inhalation
SCM, Scalenes, External intercostal; lungs maximum volume is at base of lung not apex
Exhalation
Internal intercostals, rectus abdominis (tonal action for respiration, not flexion), external oblique
What are some causes of neurovascular compression in the neck?
Supernumerary ribs (cervical rib), Trauma, Extra muscle or scar tissues in the scalene muscles (anterior and middle), Awkward postural positions, space between T1&T2 intercostal spaces and clavicle are smaller than normal
What are some symptoms of neurovascular compression in the neck?
Neuralgic. pain, paresthesia (compressed roots of brachial plexus), Vascular (less common), cyanosis, edema, weak or no pulse; Differential diagnosis - Bursitis, CTS (carpal tunnel syndrome), disc herniation, fibromyalgia, rotator cuff syndrome, MS
Branches off the throacic aorta.
subcostals, posterior intercostals
First branch of subclavian artery.
internal thoracic artery (anterior intercostals off this)
What artery is the lateral thoracic artery a branch of?
axillary artery
Anterior intercostal veins drain into?
internal thoracic vein
Posterior intercostal veins drain into?
1st to brachiocephalic vv.; 2nd, 3rd & 4th form the Superior intercostal vv.; 4th-11th to the azygos or hemiazygos vv.’s (also an accessory hemiazygos vv.); azygos only seen on Right side of body (no L counterpart); azygos vein is the main vein draining into the IVC
Subcostal veins drain into?
inferior vena cava
Potential causes of gynecomastia?
puberty; steroid abuse (cycle is about 90 days, can develop in less than 1 cycle); obesity (more prevalent cases tend to not be associated with obesity); marijuana use (questionable); tumors; genetic disorders; chronic liver disease (creates hormonal issue with FSH and LH); side effects of many medications; castration (testicular tumors); Klinefelter Syndrome (congenital malformation); Gilbert’s Syndrome (congenital malformation); Aging (movement of fat)
Suspensory ligament of the breast.
Cooper’s (created by collagen)
Breast Microanatomy
Extensive amount of collagen fibers represented by dense regular and dense irregular collagenous tissue; associated to the glands (lactiferous glands and duct glands); Mitosis of epithelial cells creating more ducts from primary ones, increasing circulation; Progesterone levels when high, will potentiate prolactin, creating more ducts and keeps present ducts open (occurs naturally during lactation)
Arterial supply of the breast.
Internal thoracic arteries and its perforating branches supply a medial part of the breast. Lateral thoracic artery supplies a lateral part of the breast. Deepest tissues are supplied by intercostal arteries and their branches.
Main venous drainage of the breast.
axillary vein
Innervation of the breast.
segmentally supplied by anterior and lateral branches of the 4th-6th intercostal nerves
The size/shape of the _____ will affect the size/ shape of the diaphragm.
liver
Pectoral Implants
Subglandular - massive results without the natural look (May cause problems with breast feeding due to the loss of sensitivity that affects the milk ejection reflex - especially if they go through the alveolar to implant); Submuscular - more natural with lift
Pectoralis Major Ruptures
Common Cause: Too much weight while bench pressing; Acute symptoms - Pain, extensive swelling, and ecchymosis (hemorrhage) of the anterior chest wall, axilla, and medial aspect of the affected arm; Chronic symptoms - Complain of weakness and partial loss of shoulder range of motion, without any notable limitation with activities of daily living
